Results of laparoscopic and open distal gastrectomies in patients with gastric cancer. Meta-analysis of Russian and European studies.

Abstract

Objective: to compare the results of laparoscopic and open distal gastrectomy in patients with gastric cancer according to Russian and European studies. Materials and methods: we searched the e-library, the Cochrane Library and PubMed. Literary references, tables of contents of specialized journals and protocols of research not yet completed have been studied. Statistical calculations (mean difference - MD, odds ratios - OR, 95 % confidence interval – 95 % CI) and meta-analysis graphs were performed using RevMan 5.4 software. Results: ten primary sources met the inclusion criteria (4 researches from the Russian Federation and 6 from other European countries). Laparoscopic and open gastric resections did not differ in the number of lymph nodes removed (MD = ‒1.31, 95 % CI from 3.51 to 0.89, p = 0.24). At the same time, laparoscopic operations are accompanied by less intraoperative blood loss (MD = –163, 95 % CI ‒268 to ‒57, p = 0.002), and open operations are shorter (MD = –38, 95 % CI –71 to ‒17, p = 0.004). The period of hospital stay is shorter after laparoscopic resections (MD = –4.1, 95 % CI –8.02 to –0.14, p = 0.04). Differences in mortality are not statistically significant (OR = 0.83, 95 % CI from 0.45 to 1.54, p = 0.55), but significantly lower after laparoscopic operations (2.3 %, 12/516) than after open (3.4 %, 92/2702), as well as the frequency of complications - 31.8 % (153/481) and 35.7 % (935/2658), respectively (OR = 1.05, 95 % CI from 0.84 to 1.37, p = 0.67). The overall five-year survival rate after laparoscopic operations varies from 48.1 % to 63.6 %, after laparotomy - from 43.4 % to 55.7 %. However, scattered and incomplete information on long-term outcomes did not allow a formal meta-analysis on comparative survival at this stage. The high level of performance of technically complex surgical techniques made it possible to significantly reduce the differences in duration between open and laparoscopic interventions (RS = ‒27, 95 % CI from 77 to 22, p = 0.28) and the duration of inpatient treatment after minimally invasive operations (RS = - 8.97, 95 % CI from ‒13.48 to ‒4.47, p <0.0001) in the subgroup of domestic studies. Conclusion: the direct results of laparoscopic subtotal distal gastric resections in Russian and European studies do not differ in terms of the amount of harvested lymph nodes, the number of complications and postoperative mortality. It is difficult to reliably assess the life expectancy of patients due to the lack of sufficient information at this stage, which requires the continuation of further research.